Livelihoods and nutrition

The management of malnutrition in children in India gets fresh impetus with the launch of a new standardised protocol. The new protocol emphasises identifying malnourished children and lays down an elaborate process for caring for them through Angawadis and the medical ecosystem. Providing incentives to Angwanwadi workers based on their performance will help speed up the adoption of the new protocol. Incorporation of Assam’s “Buddy Mother” concept into the national protocol is certainly a matter of great pride for the state and reflective of innovative and best practices employed in the state for caring for children suffering from severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). Under this practice, the mother of a healthy child becomes the “Buddy mother” of a malnourished child in the same Anganwadi centre, and they meet every week to discuss nutrition management with their children. Data from the National Family Health Survey (NFHS)-5 (2019-2021) shows that despite a reduction compared to the NFHS-4 round, 35.3% of children under 5 years of age in the country are stunted, 19.3% are wasted, and 32.1% are underweight. The “Global Action Plan on Child Wasting” of UNICEF underscores the urgent need for developing and scaling up radically improved solutions addressing the fundamental drivers of malnutrition, while mentioning that the immediate drivers are frequent common childhood illnesses and unhealthy diets. The UNICEF approach to “preventing and reducing wasting generally requires that children are born to healthy, well-nourished mothers who receive appropriate antenatal care and live in households with access to adequate food and care practices as well as functional quality primary healthcare services, potable water, safe sanitation, and good hygiene.” Nutritional support and other nourishment in the first 1,000 days from conception to birth of every child are critical to achieving the national target of reducing child stunting, underweight, and low birth weight. The new protocol notified by the Ministry of Women and Child Development points out that in India, the highest burden of undernutrition occurs between birth and two years; therefore, preventive measures need to predominantly address undernutrition in children under 2 years. The national flagship programme, POSHAN Abhiyaan, is aimed at improving the nutritional status of adolescent girls, pregnant women, and lactating thers. POSHAN 2.0 focuses on diet diversity, food fortification, leveraging traditional systems of knowledge, and popularising the use of millets. The northeastern region, a treasure trove of traditional knowledge, can lead the country in terms of leveraging it to address nutrition issues, provided adequate funds are allocated to the states in the region for undertaking research and documentation of the knowledge system. Millets returning to farmlands in the region is an encouraging development. Commercial success and affordability will make it crucial to put it on food tables in every household, in addition to its mandatory inclusion in government-supported hot-cooked meals served at Angawadi centres. Growth monitoring and screening for identification of SAM/MAM children for timely medical care and providing sufficient nutritional support need to ensure the active participation of parents in the process so that they too can play their part at home to supplement the efforts of the Angwanwadi centres. The appetite test for SAM children is an important component of the protocol as it will help Angwanwadi workers to refer those SAM children who fail the test of the appetite for hot cooked meal to the Nutrition Rehabilitation Centres established in the nearest health facility and those passing it for enrolment under the supplementary nutrition support and referred to the primary health centres for an assessment of their health within 3 to 5 days of the tests to identify any health issue, hidden infection, or danger sign. Such a combination of Anganwadi centres and health facilities can be expected to ensure a correct assessment of the health issues of SAM children. The incorporation of panchayats into nutritional intervention is another crucial aspect of the protocol. It envisages involving members of Panchyati Raj Institutions in building awareness on malnutrition and mobilising community leaders and self-help groups to support women and child department functionaries and health workers in their efforts for malnutrition-free panchyats. The economic wellbeing of households with SAM/MAM children remains critical for achieving the desired success from nutritional intervention. Women SHGs can help augment household income by undertaking income-generating activities such as weaving, livestock rearing, and craftwork for group members. Elected panchayat bodies can also take the initiative to build common facility centres for SHGs, provide modern looms, and set up yarn banks, besides facilitating the marketing of their products at remunerative prices. Making yarn available at a cheaper price is crucial for women SHG members as well as individual weavers to increase their profit margin and the sustainability of weaving as a livelihood avenue. Once they are able to maximise their income, it will help them to take care of their children’s nutritional support by adding more nutritious items to the food table and daily diet.